Fine needle cytodiagnosis of renal tuberculosis

[Genitourinary mycobacteriosis: retrospective study of 45 cases in a general hospital]

INTRODUCTION

Genitourinary tuberculosis (GUT) is the third most frequent extrapulmonary tuberculous infection, following pleural and nodal involvement. Associated clinical symptoms are mild, and the diagnosis and treatment of this condition are often delayed.

METHODS

This study determines the clinical and epidemiological characteristics, and outcome of patients diagnosed with GUT in our center over the last 10 years. Patients with positive Löwenstein-Jensen urine or biopsy culture, or pathologic study suggestive of tuberculosis were included. Cases of multifocal tuberculosis and positive Löwenstein-Jensen, but with no urinary symptoms or radiological alterations, were considered to have mycobacteriuria.

RESULTS

Forty-five patients were analyzed (62% men; mean age, 49.4 years). Among the total, 33% had a coexisting disease (14 were infected by human immunodeficiency virus). Twenty-six patients (57%) had renal tuberculosis, 5 (11%) orchiepididymitis, and 14 (31%) were classified as having mycobacteriuria. The most frequent clinical manifestations were urination syndrome (61%), low back pain (44%), and macroscopic hematuria (12%). Ziehl stain was positive in 38% cases. Urine culture was positive for other microorganisms in 9 patients (20%). Intravenous urography oriented the diagnosis in 87.5% of cases. The average interval between onset of symptoms and diagnosis was 15 months. Cure without sequelae was obtained in 60%. Surgery was indicated in 10 patients.

CONCLUSIONS

The index of suspicion for GUT should be high when patients present with repeated urinary syndromes. The current use of imaging studies other than urography and the finding of other microorganisms in urine culture can delay the diagnosis.

Breast and cutaneous mycobacteriosis: diagnosis by fine-needle aspiration biopsy

The breast and skin are considered to be rare sites of extrapulmonary mycobacterial infection, comprising 0.1% to 0.5% of all tuberculosis cases, respectively. Fine-needle aspiration biopsy (FNAB) is a rapid and minimally invasive approach to diagnose extrapulmonary tuberculosis, and has been used successfully in identifying tuberculous lesions in the lymph nodes, thyroid, kidney, pancreas, vertebrae, and testis. Two cases of extrapulmonary mycobacteriosis diagnosed by FNAB are described: a 59-year-old Hispanic male with cutaneous mycobacterial infection of the head and neck region, and a 58-year-old white male with a unilateral tuberculous mastitis. In both instances, the FNAB material demonstrated acute neutrophilic exudate, few isolated aggregates of epithelioid histiocytes and lymphocytes, and on Fite-Farraco stain mycobacteria. Reported cases of tuberculosis diagnosed by FNAB have been few; this is the first case of cutaneous tuberculosis diagnosed by FNAB.